Screening for an Anxiety Disorder: Family Member

If you think a family member may be suffering from an anxiety disorder, ask him or her to answer the questions below and print out the results to share with a health care professional.

To locate a specialist who treats anxiety disorders, visit the ADAA Find a Therapist.

Are you troubled by the following?

Yes No

Repeated, unexpected panic attacks during which you suddenly are overcome by intense fear or discomfort for no apparent reason; or the fear of having another panic attack

Yes No

Persistent, inappropriate thoughts, impulses, or images that you can’t get out of your mind (such as a preoccupation with germs, worry about the order of things, or aggressive or sexual impulses)

Yes No

Powerful and ongoing fear of social situations involving unfamiliar people

Yes No

Excessive worrying (for at least six months) about events or activities

Yes No

Fear of places or situations where getting help or escape might be difficult, such as in a crowd or on a bridge

Yes No

Shortness of breath or a racing heart for no apparent reason

Yes No

Persistent and unreasonable fear of an object or situation, such as flying, heights, animals, blood, etc.

Yes No

Inability to travel alone

Yes No

Spending more than one hour a day doing repetitive actions (hand washing, checking, counting, etc.)

Yes No

Experience or witnessing a traumatic life-threatening or deadly event or serious injury (such as military combat, violent crime, or serious accident)

More days than not, do you experience the following?

Yes No

Feeling restless

Yes No

Feeling easily tired distracted

Yes No

Feeling irritable

Yes No

Tense muscles or problems sleeping?

Yes No

Your anxiety interfering with your daily life

Having more than one illness at the same time can make it difficult to diagnose and treat the different conditions. Depression and substance abuse are among the conditions that occasionally complicate anxiety disorders.

Yes No

In the last year have you experienced changes in sleeping or eating habits?

Yes No

More days than not, do you feel sad or depressed?

Yes No

More days than not, do you feel disinterested in life?

Yes No

More days than not, do you feel worthless or guilty?

During the last year, has the use of alcohol or drugs...

Yes No

resulted in your failure to fulfill responsibilities with work, school, or family?

Yes No

placed you in a dangerous situation, such as driving a car under the influence?

Yes No

gotten you arrested?

Yes No

continued despite causing problems for you or your loved ones?

Find out more information about helping others who have an anxiety disorder.

Contact ADAA

ADAA is a national nonprofit organization dedicated to the prevention, treatment, and cure of anxiety and mood disorders, OCD, and PTSD and to improving the lives of all people who suffer from them through education, practice, and research.